Individual
MS. SUSAN ELAINE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
12 LEACH RD, LYONS, NY 14489-9732
(315) 946-6075
Mailing address
12 LEACH RD, LYONS, NY 14489-9732
(315) 946-6075
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
015280
NY
Other
Enumeration date
11/10/2011
Last updated
11/10/2011
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